Tobacco use is the number one cause of preventable death in the U.S. Yet, compliance with evidence-based smoking cessation practices remains well below guideline recommendations. More specifically, numerous studies demonstrate a pattern in which compliance with the Agency for Healthcare Research and Quality's "Treatment of Tobacco Use and Dependence" guideline decreases as physicians move from asking about tobacco use to providing assistance and arranging follow-up. We hypothesize that health center staff will be more likely to offer assistance if they can delegate the time consuming step of assistance to an external resource (telephone quitline) The Columbia University Mailman School of Public Health and the New York Presbyterian Ambulatory Care Research Network will partner with the New York State Quitline located at Roswell Park Cancer Institute in Buffalo to test the hypothesis that implementing an "expanded vital sign" chart intervention in community health centers serving low-income, primarily African-American and Latino patients, combined with an office-based link to an external proactive telephone counseling service, is feasible and will be more effective in increasing the proportion of tobacco users who receive cessation assistance than the "expanded vital sign" intervention alone. Specifically, in the control, sites usual care includes an "expanded vital sign" chart system that prompts the medical assistant or nurse to identify smokers, offer brief advice to quit, assess readiness to quit, and offer assistance. In intervention sites, the "expanded vital sign" prompt is coupled with four proactive telephone counseling sessions (provided by the New York State Quitline) available to smokers who are prepared to quit. Smokers in the intervention sites will be linked to the Quitline through a fax or email referral system located in the health centers. Previous dissemination studies have focused on strategies to increase identification of tobacco users and advice to quit; therefore our primary outcome will be the proportion of tobacco users who receive assistance. This proposal leverages the New York State Quitline to test a model for referrals that minimizes demands on providers and therefore has the potential to enhance the effectiveness of community health centers in treating tobacco use as well as increasing the reach of evidence based telephone counseling. [unreadable] [unreadable]